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Objectives What is a Hospital Information System (HIS) and why should I care? Brief history of hospital HIS’s Problems with development of HIS Barriers to clinician adoption of new technologies Barriers to hospital adoption of HIS Potential future directions for HIS’s

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An Hour in the Life of a Hospitalist Starting your 7pm-7am shift and get sign- out from 4 daytime teams (8-10 patients each) ED calls you with a new admission Nurse calls about pt X’s headache 30min later Finally get to the ED to admit patient Get back to the floor and sign orders

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History of Computers Punch card data processing 1890 First digital computer 1940 General purpose computers 1950 First minicomputer late 1960’s First microprocessors and PC’s late 1970’s World Wide Web early 1990’s Wireless computers late 1990’s

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Original Hospital Information Systems (HIS) 1962 Initiated by Bolt, Beranek and Newman and carried out by Octo Barnett at MGH  Funded by NIH whose biggest concern was not enough MD input

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One System for all? Departmental systems became feasible in 1970’s Departmental systems develop tailored to specific application areas No common databases or database systems Best of breed theory begins to develop

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How do solve the multiple data form problem? Original Solution- Substitution  Display information we already have on computer screen What we need- Transformation  Rethink how we obtain patient information and manage patients  Understand computer technology to change how we think about patient data use

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Transfer of patients between different systems Medications dropped from lists Redundant admission orders written Documented patient information from previous system lost or difficult to interpret Orders dropped on transfer Medications mistakenly given twice

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Clinician prefer computer use for consultation but do not like data entry Opposed to extra effort unless clear benefit Do not like the inflexibility Disrupts time for the clinician patient encounter Clinician’s don’t like change Mcdonald et al 1992.

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What do Clinicians Care About Does it have the information we are used to having What is it’s usability:  Learnability  Efficiency  Memorability  Minimization of Errors  Satisfaction Nielson 1993

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National Level The Computer-Based Patient Record: An Essential Technology for Health Care -IOM report in 1991 and revised in 1997 National commitment of 50 billion dollars over 5 years toward electronic health record for all? IT czar in Washington RHIO’s and Potential for a National Health Information Infrastructure (NHII)

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NHII Idea first raised in 2001 by the National Committee on Vital and Health Statistics Distributed system of databases using standards for access Benefits in:  Cost of Care  Compliance with national guidelines  Public health notification  Research

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Physician Visit of the Future Patient physician interaction is voice recognition recorded into standard history format Physical exam is performed and commented on by device peripherals Physician uses Tablet PC’s or PDA’s to review vitals, radiology, labs, and clinician notes, etc. All physician orders are entered through the device and incorporated into note for plan E and M billing recommendations made and verified All this information could be viewed by itself and in aggregate from anywhere securely

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What’s Happening at UCH Evaluating use of a single vendor-Epic  Single database and interface system  CPOE  Decision support  Customized user views of patient information CORHIO participation

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